Pulse Check in Isle 2 Please

Should a code team member check for a pulse while providing CPR? This question or some version of it (checking a pulse during CPR) is asked in just about every class the CPR Training Company offers. But is the presence of a palpable pulse, during chest compressions, a good indicator for the quality of chest compression?

So far my research has not uncovered a specific study on this topic (there are many studies on how well someone can/cannot find a pulse). What research and feedback I can find seems to indicate a palpable femoral pulse, during chest compressions, is retrograde (back flow) of blood from the venous side of the circuit. Therefore the "pulse" felt is a reflection of a pulse. Think of it this way. If a person tosses a stone into a calm lake, a person can figure out the actual impact of the stone, the size of the stone, when the stone hit the water, and more. But our fingers are far from a fine tuned mathematical tool during CPR.

CPR Includes Many Steps

So we seem to be left with this idea….use waveform capnography instead of feeling for a pulse.Checking for a pulse is highly discouraged during chest compressions, except during the 10 second pause after two minutes (or about five cycles) of CPR. The pulse during chest compressions can only tell us there is flow and movement of blood. The actual source and direction of the flow is unknown and cannot be used as an indicator of chest compression quality. Remember a pulse during compressions is only a reflection of some sort of flow….any flow….even poor flow going the opposite direction.

So we seem to be left with this idea….use waveform capnography to assess the quality of chest compressions instead of feeling for a pulse during chest compressions.

The next time a colleague mentions that a patient has a good pulse with CPR, remember that it is not necessarily an indicator of perfusion quality, or high quality CPR at all. Instead look at your waveform capnography device and smile.